Limited access to prenatal care and a high infectious disease rate have contributed to New York’s standing as the 29th-ranked state in a report issued yesterday by the United Health Federation, a drop of three spots versus last year.

According to the report, only 63.8% of women receive adequate prenatal care in New York State.

A Medicaid representative at the New York University Downtown Hospital Prenatal Care Assistance Program, Mary Lee, said care is available to all pregnant women, regardless of income or citizen status. Ms. Lee attributed the low prenatal care figures to lack of awareness and a fear of deportation among immigrants.

“Many people don’t know about these programs,” she said. “Some women are also scared. There’s a misconception that because it’s a federal program, they think it’s probably inked to INS.”

Access to health care programs is an issue on many New Yorkers’ minds these days. About a week ago, a state commission proposed closing nine state hospitals, five of them located in the New York City area. Council Member Helen Sears, who leads the City Council’s task force on hospital closings, said that it would be unfair to assume that the closings could influence how New York performs in future health reports.

“I don’t see figures changing, but I wouldn’t even speculate on that,” she said. “Health services and technology are always changing.”

One figure that changed slightly from last year’s report was the infectious disease rate. While New York is still high on the list compared to other states, this year’s figure showed a 3% decrease versus 2005. Out of 100,000 people, the report said there are typically 44 cases of infectious diseases.

The report, titled “America’s Health Rankings: A Call to Action for People & Their Communities,” considered factors such as the conditions of work and living environments, the quality of medical care, and health-related decisions by public and elected officials.

Maintaining an overall theme of improvement, the rankings listed both of New York’s main weaknesses under the heading “Challenges.” The State Department of Health was still in the process of reviewing the report yesterday, a spokesman said. Representatives of the city’s Department of Health and Mental Hygiene were unavailable for comment.

While stressing areas for updating, the report also praised New York for its high per capita spending on public health, which it averaged out to $316 a person.

One field where this investment may have paid off is mortality rates. Driving-related deaths, for example, were relatively low, with one per 100,000,000 miles driven, and deaths involving occupations were also minimal, at four deaths per 100,000 workers. The number of cancer deaths was small as well, at roughly 190 per 100,000 people.

For the sixth year in a row, Minnesota took the top spot in the rankings. Rounding out the top five were Vermont, New Hampshire, Hawaii, and Connecticut. Louisiana, ranked 49th last year, was listed as the least healthy state.